Women, Politicians & Doctors

Isabel Metcalfe, who was in charge of recruiting women to hit Stéphane Dion’s target of one-third female Liberal candidates, told me that women need to be convinced. “There’s always some guy who thinks he’d be terrific,” but women are “reticent.”

Family is usually what’s holding them back. Provincial or federal politics means weeks at a time away from home, and that conflicts with the larger share of domestic baggage women still carry.

It happens in the best of families. In this week’s New York Times Magazine, Kerry Kennedy — daughter of Bobby and Ethel — was asked if she has ever considered running for office. She said she has thought about it, but her children are 13 and 11, “and as a single mother, I think that would be just too tough on our family. Their father is a politician.” (Kennedy was very publicly divorced from New York’s attorney general, Andrew Cuomo, in 2003.)

If a daughter of the U.S.’s most storied political family thinks running for office is too hard on the home life, there seems little hope for the rest of us.

So how do we get women to chuck the hubby and kids for life in a fishbowl? If we wait until men are willing to take up the domestic slack before women take a bigger role in public life, well, we’ll be waiting a long time.

But perhaps Baby Boomers, women of Penny Collenette’s vintage, will start answering the call in greater numbers. In their 50s and 60s, they’ve had their careers, raised their families, done fine charity work, had enriching life experience, and sure understand what’s facing everyday families.

Come to think of it, just what we want in our politicians.

Let’s face it, the job isn’t made for men or women who have families. The numbers of women who have entered previously male professions and taken on men’s jobs in the last several decades have not changed to nature of the work itself very often. On that theme, it’s interesting to look at what’s happened to the nature of family practices in medicine over the same time period.

Over the last several decades, Ontario has experienced a severe reductionin the number of family practice doctors available to take on new patients such that the lack of doctors has caused a crisis in rural and even some suburban areas. To a certain extent, this crisis can be attributed to short-sightedness about the number of doctors who would be needed – the government of Canada understood the rapid increase in cost of running the health care system as being physician driven and, in their wisdom, reduced the number of available places in Canadian medical schools by 10%. Brilliant. It’s a little more complicated than that, but suffice to say, there would now seem to be about 5 million people in Canada with no primary care physician – count me as one of them.

There are other factors that have contributed to the problem but the increasing numbers of female medical school graduates are part of it. It’s now well-documented that women practice differently than men. For one thing, they work shorter hours:

Female doctors constitute half the graduating classes, further reducing capacity, as female doctors, on average, work shorter hours during the child-rearing years.

However, it’s not quite as simple as it looks. For one thing, it’s in the years before their children are in school full-time that female family doctors work fewer hours than their male counterparts. For another, though the fall in numbers of hours worked per week is greater in the case of women, male family doctors are also working fewer hours than their predecessors:

The hours worked per week decreased slightly for all physicians, both male and female. Preferred hours of work in 1999 were 37.2 for males and 31.0 for females. Preferences for hours worked and satisfaction with the balance between work and home life were important in predicting the hours worked. Those who were satisfied with the balance in both 1993 and 1999 worked 35 hours a week in 1993 and 33 hours in 1999. Those who felt the balance was not good at either time were working 48 hours in 1993 and 47 hours in 1999. Physicians without children, and women having a physician as spouse, or having a child under six, worked fewer hours. Women with all children at school worked longer hours. [download pdf]

While men have become increasingly less likely to enter the medical profession than women – some attribute this to the remunerative and status appeal of computer science and business careers – those who do become family doctors don’t find the 80-hour work weeks of older doctors any more appealing than women. Watching women transform practice to allow themselves time with family just may have rubbed off on their male counterparts, making the entry of women into the profession a factor that has actually changed the way the work is done. However, when male physicians work fewer hours, the explanation is a little differentthan it is for women:

… we could see it as taking our role as healers seriously, making time for our own inner lives, trying to achieve a balance between an active and a more contemplative life.

Hmm. women are taking time off to raise their children and men are taking time off to find themselves. In that way, it doesn’t seem likely that the change in workplace dynamics has changed much with respect to the division of labour within the home.

In addition, there’s evidence that the focus of family practitioners has changed and that the change appears to have originated with women, who provide fewer services but spend more time with their patients. [download pdf] That’s not necessarily a bad result. As one analystnotes

It’s not all bad if more time with a patient means fewer visits in the end …

Considering the complexity of so many of the health problems in family practice – chronic pain, occupational traumas and stresses, the so-called somatoform disorders, family dysfunction, anxiety/depression and so on – this [increased focus on counseling] is encouraging, especially if it signifies more time with patients and improving counseling skills. Counseling can be shared with nurses, social workers, and other more specialized counselors. But in the assessment and therapy of complex disorders, counseling skills are clinical skills. It is also significant that the great majority in both surveys offered psychotherapy. We do not know what form this takes, but it does suggest that the respondents regard it as important to family practice. There will be some that do not welcome this trend. I urge them to think again. Of all fields of medicine, family practice can show medicine how to transcend the artificial division between mind and body, which runs through medicine like a fault line. It is the kind of relationship we have with patients that distinguishes us more than anything else, and “psychotherapy” may be another word for the emotional intelligence we need in our relationships and our clinical judgements.

For reasons of decreased supply, women have found it possible to maintain practices wherein they are able to control both their hours and the way they work and thus, arguably, to change the way medicine is practiced and their working conditions. In order to attract increasing numbers of women, other areas of work, like politics for instance, will likely have to show themselves capable of allowing this kind of change and flexibility. Short of the revolution, such a change will require a change in economic conditions. But likely not the kinds of changes we’re seeing today.

Equal Voiceis tracking the numbers of women nominated, by party, and the numbers of women in “winnable” ridings, as compared to 2006. Keep an eye out.